Perifoveal Exudative Vascular Anomalous Complex (PEVAC): Retinal Vascular Density Findings

Abstract

Objectives: This study aimed to describe the clinical, optical coherence tomography (OCT) and OCT angiography (OCTA) findings and characteristics in patients with perifoveal exudative vascular anomalous complex (PEVAC) and compare the macular vascular density with the age-matched control group. Methods: We conducted a case-control study to compare demographic information, clinical observations, and OCT/OCTA findings in eyes with PEVAC (n = 5 eyes in 5 patients) and a control group of subjects matched for age (n = 9). The Advanced Retina Imaging (ARI) network algorithms were utilized to evaluate OCTA observations. Statistical analysis was performed by the nonparametric Mann-Whitney U test. Results: Patients with PEVAC had a mean (±SD) age at presentation of 70 ± 12.6 years, the mean follow-up period was 7.8 ± 5.2 months, and unilateral disease was observed. Four out of the five patients in our cohort had a history of systemically treated hypertension and dyslipidemia. Three eyes had lesions in the inner temporal retinal zone, while the remaining two eyes had lesions in the inner inferior or central zone. Retina slab analysis using OCTA showed no significant difference in vascular density parameters between the PEVAC and control groups. Conclusions: Although limited by a small sample size, our study suggests that macular vessel density shows no significant difference between PEVAC cases and control eyes.

Keywords: ARI network; OCTA; PEVAC; vessel density.

Figure 1

Pseudocolor (A) and autofluorescence (B) ultra-widefield Optos images showing a perifoveal isolated aneurysmal lesion of P-5 (arrowheads).

Figure 2

B-scan with slab segmentation (highlighted between the yellow dotted lines) and OCTA imaging PEVAC eye and a control eye. Panel (A) represents the retina slab of the left eye in patient P-2. Panel (B) represents the choroid slab of the left eye in patient P-2. Panel (C) represents the retina slab of the right eye in patient C-3. Panel (D) represents the choroid slab of the right eye in patient C-3.

Figure 3

Optical coherence tomography angiography (OCTA) imaging of the right eye in patient P-2. (A) Superficial angio en face perfusion map showing the 9 zones (the central zone and the inner and outer nasal, temporal, superior, and inferior zones). (B) A retina slab image of the same eye shown in (A). (C) A skeletonized image of the retina slab shown in (B).

Figure 4

OCTA of the affected eye in patient P-4, confirming the presence of perifoveal capillary abnormalities (crossing lines) in the superficial capillary plexus (A) and deep capillary plexus (B). (C) B-scan image showing the presence of an isolated, well-defined perifoveal aneurismal lesion (purple line) with small intraretinal cystoid macular edema close to the PEVAC lesion.

Figure 5

OCTA images of the retina slab in the affected eye of PEVAC patients and one control eye. Panel (A) represents the left eye of patient P-1, panel (B) shows the left eye of patient P-2, panel (C) displays the left eye of patient P-3, panel (D) shows the left eye of patient P-4, panel (E) shows the right eye of patient P-5, and panel (F) shows the right eye of control subject C3. The PECAC lesion(s) are marked with a green asterisk.